OBAMA: MEDICARE NEEDS ‘MODEST REFORMS’ -- President Barack Obama early in his State of the Union address last night said he’s ready to make “modest reforms” to save Medicare for the future. He pointed to old favorites like cutting subsidies to drug companies, charging wealthier seniors more and adding to delivery reform and payment changes started under his health care law. “The biggest driver of our long-term debt is the rising cost of health care for an aging population,” Obama said last night. “And those of us who care deeply about programs like Medicare must embrace the need for modest reforms — otherwise, our retirement programs will crowd out the investments we need for our children, and jeopardize the promise of a secure retirement for future generations.”

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OBAMA’S ACA COMMENT DRAWS REBUKE – Before the speech even ended last night, Republicans pounced on this line: “Already, the Affordable Care Act is helping to slow the growth of health care costs.” That was Obama’s only overt reference to his health law, but Speaker John Boehner’s office and Senate Republicans used it to launch broader attacks on Obamacare. Here’s the main message from Boehner: “Obamacare is driving up costs, jeopardizing coverage and making it harder for small businesses to hire.” Senate Republicans pretty much said the same.

--Obama’s ACA claim is still an open question, according to the POLITICO fact-check. See it here: http://politi.co/Wk4xLB

--That was pretty much it on the health care front. Obama made a case for investing in mental health care for returning veterans, but he left out mental health during the section on mass shootings.

--And then PhRMA put out a 400-word statement an hour later reminding everyone of how hard they’d fight cuts to Medicare Part D. “The president’s proposal to tamper with a program that works well would not yield any benefit for seniors,” PhRMA SVP Matthew Bennett said.

RUBIO: DEMS BANKRUPTING MEDICARE – Sen. Marco Rubio used the GOP response last night to accuse Obama of putting Medicare on the path to bankruptcy, and the Florida Republican said he would never propose any reforms that would hurt his mother. “Medicare is especially important to me,” Rubio said. “It provided my father the care he needed to battle cancer and ultimately die with dignity. And it pays for the care my mother receives now.”

MORE RUBIO: OBAMACARE BAD -- Rubio also said the president’s health law is failing to help middle class Americans afford insurance — proof that government programs meant to help the middle class usually wind up hurting it instead. “Some people are losing the health insurance they were happy with,” he said. “And because Obamacare created expensive requirements for companies with more than 50 employees, now many of these companies aren’t hiring. Not only that: They’re being forced to lay people off and switch from full-time employees to part-time workers.”

HOW DID HE LEAVE OUT OBAMACARE? — Sen. Rand Paul’s tea party response touched on hot buttons — taxes and spending of course, but also flag-burning Egyptian radicals, government printing presses, flat taxes, school choice, term limits, Montesquieu and free markets. But not a word on Obamacare. Maybe he’s saving it for next year.

Happy Wednesday and welcome to PULSE, where we’re wondering if it’s too early to start sending in prebuttals to next year’s State of the Union .

“My brain is on the PULSE, but this is what the doctor ordered.”

TODAY ON POLITICO PRO:

--YET ANOTHER SIGN BERWICK WILL RUN FOR MASS. GOVERNOR -- Former CMS chief Don Berwick put $100,000 of his own money into a prospective gubernatorial bid on Tuesday. http://politico.pro/WjxKWQ

--REID: NO TIMELINE FOR TAVENNER HEARING — Senate Majority Leader Harry Reid didn’t have an answer for reporters yesterday about when to expect a confirmation hearing for CMS acting administrator Marilyn Tavenner. http://politico.pro/YbOLS8

WALKER BREWING SOMETHING DIFFERENT ON MEDICAID -- Gov. Scott Walker is set to announce his decision on the Medicaid expansion today, and it may turn out to be something pretty unexpected. The Milwaukee Journal Sentinel reported yesterday that Walker won’t pursue the full expansion but will instead propose a “middle path.” Legislative leaders in the state yesterday afternoon told the paper they still weren’t sure what’s in Walker’s plan, which — either coincidentally or intentionally — will be announced the same day that Families USA and Wisconsin consumer advocates are hosting a press call pressuring Walker to expand the program. Walker’s decision comes about a week after he took to Facebook to express reservations about the Medicaid expansion. The Journal Sentinel story: http://bit.ly/WiJOaS

--Expect Walker’s announcement to come a little before 3 p.m., when he addresses the Wisconsin Manufacturers and Commerce Business Day.

** A message from the American Medical Association: Since 2001, average annual Medicare physician payment updates have been 0.29 percent — meaning rates have essentially been frozen — while medical practice costs have risen 25 percent. Such thin operating margins are impeding investments that are needed to implement new and improved methods of delivering care. **

NEW HAMPSHIRE WILL PARTNER UP -- New Hampshire Gov. Maggie Hassan will apply for a partnership exchange by the end of this week, a top aide for the Democrat told lawmakers Tuesday. The state will look to run both plan management and consumer assistance in the federal-state partnership, according to The Associated Press. The AP story: http://bit.ly/14QStFj

REPORT: ILLINOIS PARTNERSHIP APPROVED -- HHS Secretary Kathleen Sebelius will announce that Illinois’s application for a partnership exchange has been approved during an appearance with Gov. Pat Quinn this afternoon, sources told the Chicago Sun-Times. Quinn is still hoping to switch to a state-run exchange in 2015. The Sun-Times story: http://bit.ly/Xz7cyi

ROCKY TARGETS PRESCRIPTION DRUG ABUSE -- Sen. Jay Rockefeller (D-W. Va.) sent out three letters yesterday asking federal agencies to address prescription drug abuse. Along with Tennessee Republicans Bob Corker and Lamar Alexander, he asked the GAO to do a study on symptoms occurring in newborns exposed to addictive, illegal or prescription drugs. Rockefeller also asked CMS about how the agency addresses prescription drug abuse among Medicare and Medicaid beneficiaries, and he asked the FDA about efforts to improve patient and prescriber education of methadone. The GAO letter: http://1.usa.gov/12cTSHB. CMS: http://1.usa.gov/UbF08O. FDA: http://1.usa.gov/12JTqjX.

URAC STEPS UP ACCREDITATION BATTLE -- URAC, an accreditation organization, is trying to grab a slice of the market for certifying health plans sold on new health insurance exchanges. The group is going up with an ad campaign in Hill publications starting today, taking a not-so-veiled swipe at the competing NCQA. So far, NCQA and URAC are the only groups authorized to accredit exchange plans, though HHS could add more later on. The URAC ad: http://politico.pro/Z8qfGu

TODAY: ZEKE TO MEET WITH MODERATE DEMS -- Zeke Emanuel, the former NIH official and White House adviser, is chatting today with members of the New Democrat Coalition about health care cost containment initiatives.

WELLPOINT TAPS NEW CEO -- The nation’s second largest private health insurer announced Joseph Swedish will take over as CEO, months after Angela Braly stepped down from the job. Swedish joins the company after serving as president and CEO of Trinity Health Corporation since 2004. His first day on the job is March 25.

The New York Times dissects a complex medical question: Should Medicare cover brain scans for seniors that could detect Alzheimer’s disease? http://nyti.ms/XwqUyA

Democrats promised the health care law wouldn’t extend coverage to illegal immigrants, but many are still benefiting from the law’s Medicaid expansion, Kaiser Health News reports. http://bit.ly/X6pXtM

Medicaid leaders expect the program’s new enrollees next year will bring different challenges than those presented by the current beneficiaries, writes McClatchy Newspapers. http://bit.ly/12dUNaS

A hospital southeast of Dallas has become the ninth in three years to lose its Medicare and Medicaid funding after regulators said nursing failures led to two deaths, reports the Dallas Morning News. http://dallasne.ws/WZ9PvR

Some have already complained that the push toward electronic health records is yielding disappointing results, but it’s still way too early to tell, according to Commonwealth Fund President David Blumenthal in an essay for the Annals of Internal Medicine. http://bit.ly/XJ174v

A bipartisan group of lawmakers are pushing a law improving mental health care, but some of them haven’t supported similar bills in the past, according to the Huffington Post. http://huff.to/12sCUAv

** A message from the American Medical Association: The sustainable growth rate (SGR) is a major barrier to delivery and payment reforms that can improve the quality of patient care while lowering growth in costs. Physicians facing the constant threat of severe SGR pay cuts cannot invest in care redesign. The first step in moving to a higher performing Medicare program must be the elimination of the SGR. There is broad support for moving to a new generation of physician payment models that reward physicians who demonstrate accountability for the value, quality and costs of their patients’ care. All but three states have at least one Medicare accountable care organization, and payment and delivery innovations such as medical homes and bundled payments are occurring around the country. Ensuring that physicians can lead in the development of these new models will result in a higher performing Medicare program for patients and their physicians. Go to www.ama-assn.org/go/medicarepayment for more information. **

Authors:

About The Author

Jason Millman is POLITICO Pro’s Deputy Health care reporter. He’s on his second tour of duty at POLITICO after a stint at the Washington Post’s Wonkblog and has covered health care since graduating from Boston University with a journalism degree in 2008.